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  1. Mabachi, Natabhona M. PhD, MPH
  2. Cifuentes, Maribel RN
  3. Barnard, Juliana MA
  4. Brega, Angela G. PhD
  5. Albright, Karen PhD
  6. Weiss, Barry D. MD
  7. Brach, Cindy MPP
  8. West, David PhD


The Agency for Healthcare Research and Quality Health Literacy Universal Precautions Toolkit was developed to help primary care practices assess and make changes to improve communication with and support for patients. Twelve diverse primary care practices implemented assigned tools over a 6-month period. Qualitative results revealed challenges practices experienced during implementation, including competing demands, bureaucratic hurdles, technological challenges, limited quality improvement experience, and limited leadership support. Practices used the Toolkit flexibly and recognized the efficiencies of implementing tools in tandem and in coordination with other quality improvement initiatives. Practices recommended reducing Toolkit density and making specific refinements.